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Beyond a building: Overcoming Barriers to Accessing Primary Healthcare in Sauka Community

Water, electricity and good roads are some of the basic amenities every community needs to thrive, while health and education are the foundations of a productive society. Communities that lack these services often experience challenges as their absence slows down development. Indigenous communities in the Federal Capital Territory are amongst the most underserved in terms of their access to basic social amenities, vital for their wellbeing. Sauka, located about 30 kilometres from Abuja’s city centre, is one such community.
 
For years, although it was in the plan of the Federal Capital Development Authority (FCDA), Sauka community did not have a Primary Health Centre (PHC).

Without health nothing else matters
The role of primary healthcare in ensuring that citizens at community level have access to quality healthcare cannot be understated. One of the tenets of Universal Health Coverage (UHC) is access to affordable healthcare that is close to the people they are meant to serve.

Image credit: Nigeria Health Watch

It is estimated that throughout the course of a person’s life, primary healthcare should meet 80–90% of their health needs. Stakeholders have continued the push to strengthen primary healthcare in Nigeria; with initiatives like the Basic Health Care Provision Fund (BHCPF), government is putting instruments in place to improve service provision in PHCs. However, a house can only be built if there is a foundation. What happens if there is no PHC in the first place? This was the case for Sauka community before the Rotary Club of Abuja Metro decided to do something about it in 2018.
 
The club had supported the provision of basic social amenities in the community in the past. In 2011 they drilled a borehole that served the community for years until it deteriorated. Several years later, they built classroom blocks, a library, and a head teacher’s office and these continue to serve the community, till today. Then in 2018, they returned to build the PHC.

Image credit: Nigeria Health Watch

Taking it one step at a time
The first thing the team that conceived the idea did was to put the idea to the Rotary Club’s general assembly to get their buy-in, to begin the ‘star project’ as they sometimes called it. “Once the club gave approval, fund-raising started while the assigned team commenced other external processes like engaging with relevant agencies”, said Emmanuel Mmadu, a structural engineer, and the club’s former Director of Community Service. One of the project’s driving forces were the stories of women in labour who travelled 25 kilometres on motorbikes to give birth at the nearest health facility.
 
The assigned team members met with FCDA officials to get the necessary approvals and directives regarding where to site the PHC. They then went to the National Primary Health Care Development Agency (NPHCDA) to get the correct prototype for constructing PHCs.

Image credit: Nigeria Health Watch

The team also conducted a feasibility study and budget analysis using the allocations in the FCT’s budget as a guide. One thing was certain, the project required a lot of money. But that wasn’t a deterrent to them as “it is not compulsory that the administration that started it must finish it because it’s a continuum,” said Mmadu. This contributed to the success of the project as it passed through four club presidents who supported the project, with successive administrations working on different phases of the project. To help raise funds for the project, they carried out several fund-raising events, sometimes before a new president was installed.
 
Volunteerism was a huge part of the process as “members also volunteered any, some, or all the three ‘Ts’ they could — time, talent, or treasure”, said Mmadu. The community members also contributed by volunteering to fetch water as this was a major challenge. But for them to do this, it took a lot of convincing. “Initially, they saw it as a government project and wanted to be paid for everything they did”, Mmadu said. But his team successfully managed the expectations of the community members. “We explained everything to the community leaders, made them understand that the funds were donations made by individuals and as such must be accounted for”. Language was a huge barrier in the beginning, but this was overcome by engaging translators.
 
Benefits but still a long way to go
The PHC was completed and officially handed over to the government and the community on February 27, 2020. However, the project has not reached completion as staff quarters for the health workers are still being constructed.

The Sauka Primary Healthcare Centre built by the Rotary Club of Abuja Metro and donated to the community in 2020 has helped meet the healthcare needs of the residents and neighbouring communities. Photo credit: Nigeria Health Watch

The government made a lot of promises”, Mmadu said. They were responsible for posting staff to the PHC, paying their salaries and ensuring that they have essential medicines and other resources for patients. This was initially the case and the PHC bustled with activity as the health workers posted there by the Abuja Area Municipal Council (AMAC) took charge of the PHC. But with time, this waned as they left due to non-payment of their salaries and allowances. Some stayed back to volunteer but left after some time. The officer-in-charge, popularly called Madam Victoria by the community members, is the only health worker left at the PHC now.
 
According to Madam Victoria, some of the challenges the PHC is experiencing are linked to the access road leading to the facility, as it is in a bad state. In addition, the community members expected to access services free of charge, so they were not happy when they were asked to pay. She added that the location of the health facility might also be a contributing factor to the low patronage, as not many people know about the PHC, especially since their signpost was damaged and removed by scrap collectors.
 
The community chief, Bala Zaki said that at some point, community members were given prescriptions and asked to buy their own medication. This, he said, discouraged them from going back to the PHC. Recently, the PHC was burgled, and the power generator and all electrical fittings were stolen. “Even if a new generator is provided today, we can’t maximise it because the hospital needs to be rewired again”, Victoria said.
 
Making the PHC great again
Despite these challenges, it is clear that Sauka PHC had become an important part of the community. Chief Bala said his brother’s only child was delivered at the PHC and he knows four other women who also delivered there.
 
Sauka PHC can return to its past glory, but it will take every stakeholder working together for that to happen. The community members must take ownership and take the necessary steps to ensure that the facility is protected and kept safe from intruders. The local government must remember its promises to the community and fulfill them. It is the government’s responsibility to ensure that a PHC conforms to the minimum standards which include human resources, infrastructure, and equipment. Simply put, the government must ensure that the PHC is well-staffed and that the staff has all they need to provide quality services.
 
The biggest obstacle to accessing healthcare in the community has been surmounted through the intervention of the Rotary Club. Now, that there is an existing PHC, the government should invest funds from the BHCPF, especially through the National Health Insurance Scheme (NHIS) gateway which would pay for a basic package of health services, reducing the need for out-of-pocket payments. This would help expand access to basic healthcare delivery in Sauka PHC and make steps towards improving health outcomes in the community.

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